Provider Demographics
NPI:1952607871
Name:CARYL, RENEE (RDLDN)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:CARYL
Suffix:
Gender:F
Credentials:RDLDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W 11TH ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1758
Mailing Address - Country:US
Mailing Address - Phone:814-452-2218
Mailing Address - Fax:814-455-2925
Practice Address - Street 1:240 W 11TH ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1758
Practice Address - Country:US
Practice Address - Phone:814-452-2218
Practice Address - Fax:814-455-2925
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001483133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered